Pattern, Clinical Characteristics, and Outcome of Meningitis among HIV-Infected Adults Admitted in a Tertiary Hospital in North Western Tanzania: A Cross-Sectional Study.

Matobogolo M Boaz,Stephen E Mshana,Samuel Kalluvya,Bonaventura C T Mpondo,Jennifer A Downs

doi:10.1155/2016/6573672

Abstract

Background. Limited information exists on the etiologies, clinical characteristics, and outcomes of meningitis among HIV-infected patients in Africa. We conducted a study to determine the etiology, clinical characteristics, and outcomes of meningitis among HIV-infected adults. Methods. A prospective cross-sectional hospital based study was conducted among HIV-infected patients aged ≥18 years admitted to the medical wards with symptoms and signs of meningitis. Sociodemographic and clinical information were collected using a standardized data collection tool. Lumbar puncture was performed to all patients; cerebrospinal fluid samples were sent for analysis. Results. Among 60 HIV-infected adults clinically diagnosed to have meningitis, 55 had CSF profiles consistent with meningitis. Of these, 14 (25.5%) had a laboratory-confirmed etiology while 41 (74.5%) had no isolate identified. Cryptococcus neoformans was the commonest cause of meningitis occurring in 11 (18.3%) of patients followed by Mycobacterium tuberculosis (6.7%). The in-hospital mortality was 20/55 (36.4%). Independent predictors of mortality were low baseline CD4 count and turbid CSF appearance. Conclusion. Cryptococcal meningitis is the most prevalent laboratory-confirmed etiological agent among adult HIV-infected patients with suspected meningitis admitted to medical wards in Western Tanzania. Mortality rate in this population remains unacceptably high. Improving diagnostic capacity and early treatment may help to decrease the mortality rate.

Highlights

Meningitis is common and is among the most serious infections occurring in individuals with HIV infection [1, 2]
Among 60 adult HIV-infected patients enrolled in this study, 14 (23%) of them had confirmed microbiological etiologies and 41 (68%) others had no defined isolates in the CSF though they had laboratory findings which were suggestive of meningitis
As described in two previous studies done at our hospital (BMC), cryptococcal meningitis remains a common cause of meningitis and death, among adult HIV/AIDS patients in our setting [6, 11]

Summary

Introduction

Meningitis is common and is among the most serious infections occurring in individuals with HIV infection [1, 2]. In one study done in Durban, South Africa, among HIV patients coinfected with tuberculosis (TB), the most common combination of presenting clinical features for patients suspected to have meningitis was headache and neck stiffness, seen in 78.6% of patients. Limited information exists on the etiologies, clinical characteristics, and outcomes of meningitis among HIV-infected patients in Africa. We conducted a study to determine the etiology, clinical characteristics, and outcomes of meningitis among HIV-infected adults. Cryptococcal meningitis is the most prevalent laboratory-confirmed etiological agent among adult HIV-infected patients with suspected meningitis admitted to medical wards in Western Tanzania. Mortality rate in this population remains unacceptably high. Improving diagnostic capacity and early treatment may help to decrease the mortality rate

Methods

Results

Discussion

Conclusion